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CCT - Certified Cardiographic Technician 12-Lead ECG Interpretation and Cardiac Conditions Questions and Answers Flashcards

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  1. A 12-lead ECG shows pathological Q waves (>40 ms wide, >25% of R wave height) in leads II, III, and aVF. What do these represent?

    Answer: Old inferior myocardial infarction (scar)

    Pathological Q waves in the inferior leads indicate transmural myocardial necrosis in the inferior wall, representing old or evolving inferior MI.

  2. During routine 12-lead acquisition, the technician notices the P waves in lead aVR are upright and P waves in lead II are inverted. What does this suggest?

    Answer: Lead reversal (right arm and left arm leads swapped)

    Upright P in aVR and inverted P in II are the opposite of normal and strongly suggest right arm-left arm lead reversal, which is a technical error requiring repeat acquisition.

  3. A left bundle branch block (LBBB) on a 12-lead ECG is characterized by which set of findings?

    Answer: Broad notched R in I, aVL, V5-V6 and deep QS or rS in V1, QRS ≥120 ms

    LBBB features include a wide QRS (≥120 ms), broad monophasic R waves in lateral leads (I, aVL, V5-V6), and a deep QS or rS pattern in V1 due to abnormal left ventricular activation.

  4. ST elevation in leads V7, V8, and V9 (posterior leads) with reciprocal changes in V1-V2 confirms which diagnosis?

    Answer: Posterior STEMI

    Posterior leads V7-V9 directly capture the posterior wall; ST elevation there with reciprocal depression in V1-V2 confirms true posterior STEMI, typically from circumflex artery occlusion.

  5. Which electrocardiographic feature helps distinguish pericarditis from STEMI on a 12-lead ECG?

    Answer: Reciprocal ST depression in anatomically opposite leads is seen in STEMI but absent in pericarditis

    In pericarditis, ST elevation is diffuse and concave without reciprocal depression (except aVR and V1), while STEMI shows regional elevation with clear reciprocal depression in opposite leads.

  6. A CCT performing a 12-lead ECG notes a regular wide-complex tachycardia at 180 bpm with AV dissociation. What is the most likely diagnosis?

    Answer: Ventricular tachycardia (VT)

    AV dissociation (P waves marching through at a different rate than QRS) in a wide-complex tachycardia is pathognomonic for ventricular tachycardia and should prompt immediate notification.